Health reform passage hasn't alleviated the waiting or the worrying

Passage of health insurance reform last month followed years of failure to expand U.S. health care and months of debate about whether the law will harm that care or the country.

But for most people who live with the nation's complex, pricey health system, the waiting isn't over. Neither is the worrying. Or the confusion.

The new law should increase most Americans' insurance options, outlaw some hated rules that limited coverage and insure about half the 46 million U.S. residents without coverage -- partly through a controversial fine against most people who don't get a health policy.

Insurance expansion won't kick in until 2014. And many other effects of the new health law won't be clear until politicians, regulators, insurers and the medical system hash out the details of the law and set their strategies of how to respond.

Take one key point: How the law will affect fees paid under Medicare, the federal insurance for Americans 65 and up. Payments are low enough now that many Northwest doctors won't take on new Medicare patients. Oregon legislators won a deal to raise the Northwest's payment rates closer to other regions. But the health law is partly funded by planned cuts in Medicare payments. So whether the law will raise or lower payments isn't clear.

Uncertainty also flows from how individuals and businesses react to the law. If lots of healthy people opt to pay a fine, instead of buying insurance, that would increase the overall illness level of insured people and probably raise rates. Workers who choose a private plan over an employer's offered plan might stick their company with a $2,000 fine. While the law will increase the income cutoff for Medicaid -- an insurance plan for the poor -- there's no guarantee more doctors will accept that plan's generally low payment rates. That could lengthen Medicaid members' wait times to see a doctor.

Delays in the law -- some included to pick up political support -- are another big source of uncertainty. One tax to help pay for more care starts this July: a 10 percent levy on indoor tanning. But higher taxes on investment income and high-wage earners hit in 2013. And a 40 percent tax on any employer-provided health benefits for more than $10,200 per person, or $27,500 for a family, starts in 2018.

A few benefits start this year. More than 100,000 Oregonians 65 and older can get a $250 rebate to help cover drug costs not paid by Medicare Part D, according to federal health officials. Small business owners who cover workers can claim a tax credit up to 35 percent of the premiums they pay. Kids can stay on their parents plans through age 26. In September, the law will ban several unpopular insurance practices, such as not covering children with pre-existing health problems or ending people's coverage when they get sick.

But many people must wait years for their benefits to materialize. The Medicaid expansion, new state exchanges offering individual insurance and tax credits to help buy plans all debut in 2014, leaving millions with little to do but pray for health for the next four years.

"If you don't have insurance," said Portland dancer Tere Mathern, "you definitely look differently at how you address an issue with your body. You wait longer to go to go to a doctor and you push things a little further than you might have otherwise."

With so much doubt surrounding health reform, The Oregonian spoke with people likely to see their lives changed -- somehow -- by the new law. From a soon-to-be uninsured dancer to a business owner to a doctor, we'll present their stories this week, providing snapshots of our neighbors' hopes and fears for the most sweeping domestic law to hit the United States in a generation.